Provider Demographics
NPI:1821356445
Name:OKONOLA, OWEN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:OKONOLA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13446 156TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3648
Mailing Address - Country:US
Mailing Address - Phone:646-633-3346
Mailing Address - Fax:
Practice Address - Street 1:11513 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1851
Practice Address - Country:US
Practice Address - Phone:718-558-8998
Practice Address - Fax:718-558-8999
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648706163W00000X
NY349444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse